“Repeal and replace” has been the rallying cry for opponents of the Affordable Care Act (ACA or Obamacare), the signature domestic policy of the Obama administration that expanded insurance coverage to 20 million people. Opposition to the ACA inspired populist social movements and helped elect Republicans to state and national office. Donald Trump tweeted hundreds of times that Obamacare was a “disaster” and promised to repeal and replace the health law. And yet, since he took office in 2017, public opinion polling shows that more Americans hold favorable views than unfavorable views of the law, reversing previous trends. Constituents have confronted members of Congress at rowdy town hall meetings and demanded that their health coverage be protected. Bewildered Republicans and health policy wonks are scratching their heads, trying to make sense of the sudden surge in support for what has been an unpopular law. Finally ready to make good on their campaign promises to repeal and replace, Republicans are met by desperate Americans, many with preexisting conditions, who fear their coverage will soon disappear.

Here, we explore this pendulum shift in public opinion poll results about the popularity of the ACA. We argue that, in fact, many pollsters and policy wonks never really understood the complicated assessments that people held of the ACA in the first place. A question about favorable or unfavorable views fails to capture the stakes of the ACA for those with and without health insurance. Poll data show that major reasons for disliking the health reform included increased costs, that it created too big a role for government, that it took the country in the “wrong direction” under President Obama, and that it did not go far enough in expanding coverage.

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